A new model for general practice-led, regional, community-based, memory clinics.

BACKGROUND: Dementia is a major international health issue with high impact on the patient, relatives, and broader society. Routine screening for dementia is limited, despite known benefit of early detection and intervention on quality of care and patient outcomes. Screening is particularly limited in rural and regional areas, despite high burden and projected growth of dementia in these populations. The current study aimed to implement a new general practitioner (GP) led, multidisciplinary, model of care providing dementia detection and referral pathway to a community-based specialist clinic across six regional general practices. METHODS: Cross-sectional analysis of dementia screening and referral characteristics in the St Anthony Family Medical Practices group based in the regional area of Loddon-Mallee, Victoria. Data were collected on demographics and relevant medical history. Cognitive state was assessed using the Mini-Mental State Examination (MMSE), GP Assessment of Cognition (GPCog), and Geriatric Depression Scale (GDS). Referrals and referral outcomes were recorded for geriatrician, psycho-geriatrician, or both. RESULTS: Eight hundred and eighteenth patients over 65 years were screened, accounting for approximately 24.2% of 65 and over presentations for the practice network. Of those screened, 68.9% were indicated for referral and 30.3% of these were successfully referred. Of the indicated patients who received referrals, 34.2% declined. Many who declined referral had intermediate scores on the cognitive assessments utilized. CONCLUSION: Standardised models of care, integrated within community services, are necessary to improve access to early detection, referral and quality management of dementia. The St Anthony Memory Service model will be invaluable in informing future service development, and in particular the development of services for people living with dementia in rural and regional communities.

The postpartum visit--why wait 6 weeks?

BACKGROUND: In many western countries, the traditional 6 week check is a routine medical review of a mother and her baby 6 weeks after the birth. In Australia, general practitioners perform the majority of postpartum assessments. OBJECTIVE: This article discusses some of the common issues that concern women following the birth of a baby, and the medical conditions GPs need to address in the postpartum period. DISCUSSION: The research literature does not support any benefit of a 6 week check. However, clinical evidence, our expertise as GPs, and our personal experiences, clearly indicate that the postpartum period is a time of tremendous change, increased health problems, and emotional upheaval for new parents. General practitioners are in an ideal position to assist families during this period and may consider a sooner rather than later, proactive rather than reactive, approach to postpartum care.